A Rare Case of Paediatric Neck Swelling: Cervical Sympathetic Chain Schwannoma

Schwannomas are indolent benign lesions arising from schwann cells in the nerve. They are especially rare in the paediatric population. We report an interesting case of a swelling in the upper neck, which highlights an atypical presentation of this tumour, as well as the complex details of its clinical, radiological, and surgical management. 1. Introduction Schwannomas are indolent benign lesions arising from schwann cells in the nerve. Their earliest description was at the start of the twentieth century, and they were referred to as neurinomas [1]. They are a rare occurrence, and only up to twenty-five percent are reported in the head and neck region in adults [2]. They are especially rare in the paediatric population. They have a predilection for the origin of vagus nerve in the neck but may be found arising from any other nerve with a schwann sheath. When arising from the cervical sympathetic chain, they are usually found in the superior and middle portions [3]. Schwannomas have a male preponderance and may present at any age. However, they frequently occur in middle age with a wide range between thirty to seventy years reported. We report a case manifesting as a swelling in the upper neck, which confirms the typical presentation of the tumour, and detail its clinical, radiological, and surgical management. 2. Case Report A fourteen-year-old girl presented with a one-year history of an asymptomatic slowly enlarging mass on the right side of her neck. There was no history of hoarseness, nasal regurgitation or associated pain, fever, or trauma. Her medical history was significant for recurrent tonsillitis in early childhood, but the mass was found to be unresponsive to over three courses of oral antibiotics before being referred to our specialist centre for evaluation. On examination, she had a large six-by-four centimetre immobile solitary right-sided neck mass deep to the right sternocleidomastoid muscle with a smooth regular border. There was no associated palpable cervical lymphadenopathy. The patient’s oropharynx revealed no displacement of the peritonsillar structures, and a further physical examination was non-contributory. Routine blood tests including LDH were normal. Ultrasound showed a solid, well-circumscribed homogeneous mass arising from within the fascial planes with low level Doppler venous flow. The mass was displacing the great vessels to the right (Figure 1). She went on to have an MRI (Figure 2). Figure 1: Ultrasound right neck mass. Figure 2: MRI head and neck showing a 3.9 × 3.8 × 6.1？cm lesion with a heterogeneous enhancement